A number of hand-held diagnostic instruments are commonly known in the medical field for examining a patient, such as those which are used during routine physician office visits. These instruments include, among others, skin surface microscopes which are used for diagnosing skin disorders, otoscopes permitting examination of the ear canal and tympanic membrane, and ophthalmoscopes for examining the eyes. Each of the above instruments have uniquely inherent features to allow an effective examination of the area of interest. Skin surface microscopes, for example, include a distal optical element having a relatively large diameter (e.g. approximately 15 mm) for direct placement onto a wart, lesion, or other skin disorder. Otoscopes, on the other hand, include a frusto-conical insertion portion, including a safety speculum, which prevents insertion beyond a predetermined distance into the ear canal.
It has since become desirable for a patient to be able to witness a primary care or other examination along with the physician. Therefore, videoized versions of the above diagnostic instruments have been developed, such as those described in U.S. Pat. No. 5,363,839, issued to Lankford, U.S. Pat. No. 5,239,984, issued to Cane, et al, and U.S. Pat. No. 4,947,245, issued to Ogawa, et al. In each of the referenced instruments a miniature video camera, such as a CCD or other electronic sensor, is positioned either within the interior of the instrument or adjacently coupled thereto. The electronic sensor includes a light receiving surface or substrate which receives a focused optical image of a target of interest through a specifically designed viewing system, such as a rod lens, objective or other form of lens positioned, typically in the distal end of the instrument.
A separately disposed light box or other source of illumination, provides white light through a sheathed cable tethered to the proximal end of the instrument. The cable includes an optical fiber bundle for directing the light specifically to the distal tip of the instrument, as well as electrical conductors for powering the electronic sensor. The electronic sensor, in turn, creates an analog or digital electrical signal which is remotely transmitted to a processor containing appropriate circuitry for converting the transmitted electrical signal into a video monitor-ready (PAL, NTSC) format. The processed video signal is then separately displayed on a remote monitor. The use of videoized systems has become increasingly popular and has since taken on the term "telemedicine".
Videoized diagnostic instrument systems, like those described above, are quite expensive, with each system requiring a separate diagnostic instrument, along with dedicated cabling, light source, signal processor and video peripheral device(s). In addition, each system also requires a significant space allocation, posing a separate problem considering that space is already at a premium in physician's offices and other environments where such systems would be typically be used. It is therefore desirable to provide a diagnostic instrument system which is capable of performing multiple examinations.
It is another perceived desire in the field to make such telemedicine systems sufficiently portable; for example, to allow examinations to take place outside the "normal doctor's office". Along with this need, is a similarly recognized need to allow portions of the system to be compactly arranged without the need for separate peripherals or connecting devices.
Improved organization of patient records is yet another current need in the medical field. To date, creation and maintenance of patient files has been largely a manually managed activity. Data which can form a part of the overall patient record, however, can take on a number of different forms. For example, it has been known that data can be accumulated in a number of forms, particularly with the advent of telemedicine involving image capture, such as using the above described videoized instrument systems.
In addition, physicians, such as family practitioners, surgeons, etc., invariably record notes during a patient visit and examination. In some instances, of course, the physician may write information directly into the patient's file. The course of usual practice, however, is to record events of an examination using a hand-held recording device. The taped notes are then later transcribed and then added to the patient's file. Throughout the course of a single day, however, it is possible that a physician may see as many as 40 patients. This kind of volume makes the task of compiling and transcribing notes difficult, or at a minimum time consuming, either for the physician or for the physician's staff. The creation of patient records incorporating several types of data, including audio and video data, is even more difficult.
To date, though there are a number of transcripting apparatus available, none conveniently combine audio data with other forms of collected data, such as captured images, sketches by the physician, or data obtained from other instruments to be retained and used in compiling and assembling complete examination records which can then be effectively stored and maintained.